A comparison study of prevalence, awareness, treatment and control rates of hypertension and associated factors among adults in China and the United States based on national survey data

Internal migrants with chronic diseases (IMCDs) are a specific subgroup of the internal migrants, but few studies have focused on health service utilization among this group. Social integration is an essential element in the maintenance of health and well-being in migrants. However, the measurement of social integration remains inconsistent. This study aimed to measure social integration more comprehensively and evaluate the association between social integration and National Basic Public Health Services (NBPHS) utilization among IMCDs in China, thereby providing theoretical support for health promotion among IMCDs. The data of this study were obtained from the China Migrants Dynamic Survey (CMDS) in 2017. A total of 9272 internal migrants who self-reported hypertension and/or type 2 diabetes were included in the analysis. Four factors were extracted through exploratory factor analysis to measure the social integration of IMCDs: psychological identity, community involvement, social security, and sociocultural adaptation. The results show the IMCDs underutilized NBPHS, with 26.80 % stating that they have not used any of the services in the NBPHS. We confirmed the positive association between social integration and NBPHS use among IMCDs. The social integration of IMCDs in developed regions was relatively worse than in developing regions, further exacerbating the underutilization of NBPHS in developed regions. Therefore, targeted government measures and supportive policies are necessary, especially in developed regions, to encourage IMCDs to participate in social organizations and community activities and stimulate their active participation in the NBPHS. 

Social integration and utilization of national basic public health services among China's internal migrants with chronic diseases: A structural equation modelling approach

Malignant melanoma is considered the most serious type of skin cancer. In clinical practice, the conventional technique based on subjective visual examination has a high rate of misdiagnosis for malignant melanoma and benign nevus. Polarization imaging techniques have great potential in clinical diagnosis due to the advantages of improving sensitivity to functional structures, such as microfiber. In this paper, a set of human skin tissue sections, including 853 normal, 851 benign nevus, and 874 malignant melanoma, were analyzed and differentiated using a homemade high-fidelity Mueller matrix imaging polarimeter. The quantitative result using support vector machine algorithms confirmed that, while scalar retardance yields lower accuracy rates, vectorial retardance results in greater accuracy for both the training and testing sets. In particular, the cross-validation accuracy for the training set increased from 88.33% to 98.60%, and the prediction accuracy for the testing set increased from 87.92% to 96.19%. This tackles the limitation of the examination based on clinical experience and suggests that vectorial retardance can provide more accurate diagnostic evidence than scalar retardance. Unfortunately, it is inconvenient and time-consuming to read and analyze each component of the vectorial retardance simultaneously in the qualitative assessment. To address this clinical challenge, a color-encoded vectorial retardance imaging method was implemented. This method can provide superior tissue-specific contrast and more fiber details than scalar retardance. The anisotropic microfiber variation among different skin lesions, including the orientation and distribution, can be clearly highlighted. We believe that this work will not only enable early and rapid diagnosis of skin cancer but also provide a good observation and analysis of the state of cancer progression.

/pdf/distinguishing-malignant-melanoma-and-benign-nevus-of-human-gbuemtjj.pdf

Distinguishing Malignant Melanoma and Benign Nevus of Human Skin by Retardance Using Mueller Matrix Imaging Polarimeter

BACKGROUND
The increasing prevalence of diabetes is placing important demands on the Chinese health care system. Providing self-management programs to the fast-growing number of people with diabetes presents an urgent need in rural primary care settings in China. Peer support has demonstrated effectiveness in improving self-management for individuals with diabetes in urban communities in China. A priority then becomes developing and evaluating a peer support program in primary care settings in rural communities of China and determining whether it is feasible and acceptable.


OBJECTIVE
The aims of this study are (1) to evaluate the feasibility and acceptability of a peer support approach to type 2 diabetes self-management in rural primary care settings; (2) to identify enabler and facilitator factors likely to influence the peer support implementation; (3) to provide primary data and evidence for developing a version of the program suitable for a randomized controlled trial in rural primary care settings.


METHODS
Three townships will be sampled from 3 different counties of Anhui province as the study setting. Participants will be recruited based on these counties' local primary care health record system. The peer supporters will be recruited from among the participants. The peer support program will be led by peer supporters who have completed 12 hours of training. It will be guided by primary care providers. The program will include biweekly meetings over 3 months with varied peer support contacts between meetings to encourage the implementation of diabetes self-management. Mixed methods will be used for evaluation. Qualitative methods will be used to collect information from health care system professionals, individuals with diabetes, and peer supporters. Quantitative methods will be used to collect baseline data and data at the end of the 3-month intervention regarding psychosocial factors and self-management practices.


RESULTS
The results will include (1) quantitative baseline data that will characterize type 2 diabetes self-management practices of individuals with diabetes; (2) qualitative data that will identify enablers of and barriers to self-management practices for individuals with type 2 diabetes in rural communities; (3) both qualitative and quantitative evaluation data, after the 3-month intervention, to demonstrate the feasibility and acceptability of the peer support approach for individuals with type 2 diabetes.


CONCLUSIONS
Our findings will inform the design of a tailored intervention program to improve self-management among individuals with type 2 diabetes in rural primary care settings. If we find that the peer support approach is feasible and acceptable, we will develop a larger randomized controlled trial to evaluate effectiveness in multiple rural settings in the province.


INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
PRR1-10.2196/47822.

Peer Support Self-Management Intervention for Individuals With Type 2 Diabetes in Rural Primary Care Settings: Protocol for a Mixed Methods Study.

Population-Based Behavioral Risk Factors Prevention and Control: the Fundamental Strategy for Fighting NCDs

What is already known about this topic? Since the launch of China Healthy Lifestyle for All (CHLA), each action area has been evaluated at the local level and effective results have been achieved in most areas. What is added by this report? Based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model, the study found that there is an imbalance in the development of CHLA, and some of the action goals and indicators are not satisfactory. What are the implications for public health practices? A national action evaluation index system should be built to ensure the sustainability and scientific nature of this strategy. In addition, the government needs to attach great importance to CHLA to effectively help residents take health actions.

Evaluation of China Healthy Lifestyle for All Interventions Based on RE-AIM Framework — China, 2007–2020

In recent decades, China has faced a double burden of infectious diseases and noncommunicable diseases (NCDs). The number of deaths due to NCDs accounts for 88.5% of total deaths in China in 2019. To address these public health issues and improve the accessibility and affordability of primary health care, a National Basic Public Health Service Program (NBPHSP) was introduced as part of China’s healthcare reform initiated in 2009. Subsided by national and local government budgets, NBPHSP is mainly implemented by community and township health service centers, as well as health stations in urban areas and village clinics in rural areas (1). Health management of patients with hypertension and diabetes is an integral and pivotal part of the NBPHSP. The National Health Commission successively promulgated the National Standards for Basic Public Health Services (2009, 2011, and 2017 editions) to guide the management of patients with hypertension and diabetes. As required, all primary health care institutions should provide services for detection, comprehensive treatment, and follow-up for the local hypertensive and diabetic residents above 35 years old (2). Lifestyle and behavior risk factor interventions are cost-effective to tackle NCDs and are fundamental components of hypertension and diabetes management in the NBPHSP. Yet, limited literature has evaluated its implementation in China. Therefore, this study used pragmatic approaches to recollect published data and evaluate the implementation of the behavioral risk factor intervention in NCD patients in this nationwide public health action.

Evaluating Behavioral Risk Factor Interventions for Hypertensive and Diabetic Patient Management in the National Basic Public Health Service Programs from 2009

Based on the major findings of our studies, we found that in the past two or three decades, China’s noncommunicable diseases (NCDs) prevention and control policies experienced rapid development. The service mode of NCDs management was transformed, the service capabilities at primary medical facilities were comprehensively improved, and the health literacy and action capability of residents were improved. Remarkable achievements have been made in the prevention and control of NCDs, and a lot of experience has been accumulated. However, unhealthy lifestyles among Chinese residents are still common, and the control of NCDs and related behavioral risk factors faces great challenges. Therefore, in order to implement the Healthy China strategy, early prevention and strengthening of the health management of NCDs in high-risk groups are essential.

Recommendations and Future Direction for Population-Based Prevention and Control of Behavioral Risk Factors for NCDs

Background At present, little is known about the risk factors of early postoperative death in patients with hepatocellular carcinoma (HCC). Methods We collected the data of patients who were diagnosed with primary liver cancer between 2010 and 2015 in the Surveillance, Epidemiology, and End Results database and further allocated them to the training set and validation set. Univariate and multivariate logistic regression analysis was used to determine the independent influencing factors of early postoperative death of HCC patients. Random forest and Least absolute shrinkage and selection operator regression analysis were used to screen out vital variables for the construction of the nomogram. It was evaluated by receiver operating characteristic curve, calibration curve and decision curve analysis. Results A total of 4154 patients were selected in this process, including 2647 patients with postoperative early death (outcome1) and 1507 patients with liver cancer-specific postoperative early death (outcome2). Surgery method, age category, marital status and tumor grade were the risk factors for early postoperative death. As for the liver cancer-specific early postoperative death, AJCC, surgery method, chemotherapy and tumor grade were independent prognostic factors. Early death and liver cancer-specific early death nomograms have an area under curves of 0.643 and 0.679 in the training set, respectively, and 0.617 and 0.688 in the validation set. The calibration curve and decision curve analysis shows that the nomograms have good performance. Conclusion This model provides an intuitive and practical tool for future studies based on large-scale cohorts by exploring the risk factors of early death in patients with HCCs undergoing surgery.

Risk prediction model for early postoperative death in patients with hepatocellular carcinoma: a retrospective study based on random forest algorithm and logistic regression

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Evaluation of China Healthy Lifestyle for All Interventions Based on RE-AIM Framework — China, 2007–2020

Evaluating Behavioral Risk Factor Interventions for Hypertensive and Diabetic Patient Management in the National Basic Public Health Service Programs from 2009

Recommendations and Future Direction for Population-Based Prevention and Control of Behavioral Risk Factors for NCDs

Risk prediction model for early postoperative death in patients with hepatocellular carcinoma: a retrospective study based on random forest algorithm and logistic regression